Thanks for the response!!! It turns out she did not plan to use twilight sedation but Grade IV (full) sedation – her idea I guess was she could then force my mouth open and I wouldn’t remember it. That was an even less appealing option for me [I have RA which affects my jaw/throat and manhandling my jaw didn’t sound like a good idea, awake or not].

I found another oral surgeon who does computer-assisted surgery using technology he developed, which did not require me to open my mouth so wide. [http://www.ccomfs.com/dental-image-guided-surgery-washington-dc]. We did the whole procedure in 20 minutes with only a local. I had ZERO gagging. The resulting implant is perfectly aligned. I was on pain meds for 1 day but walked home from the appointment and was alert and able to work the same day. I was ***so*** relieved and happy!!! Turns out this doctor has many patients with RA, schleroderma, etc who have limitations on how wide they can open. This technology was really a game-changer for me. Just wanted you to know! Neither my dentist or my RA doc had any idea this was available!